Individual
JORDAN DIETL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
13610 BARRETT OFFICE DR STE 104, BALLWIN, MO 63021-7818
(314) 822-5107
(314) 822-5106
Mailing address
13610 BARRETT OFFICE DR STE 104, BALLWIN, MO 63021-7818
(314) 822-5107
(314) 822-5106
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2015033703
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2015033703
OT LICENSE #
MO
Enumeration date
04/05/2016
Last updated
04/05/2016
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